ABSTRACT
OBJECTIVES: To evaluate exercise tolerance and the reproducibility of the six-minute walk test in Brazilian children and adolescents with chronic kidney disease and to compare their functional exercise capacities with reference values for healthy children. METHODS: This cross-sectional study assessed the use of the six-minute walk test in children and adolescents aged 6-16 with stage V chronic kidney disease. For statistical analysis of exercise tolerance, including examinations of correlations and comparisons with reference values, the longest walked distances were considered. The reproducibility of the six-minute walk test was assessed using intraclass correlation coefficients. RESULTS: A total of 38 patients (14 females and 24 males) were evaluated, including 5 on peritoneal dialysis, 12 on hemodialysis and 21 who had undergone renal transplantation, with a median age of 11.2 years (6.5-16). The median walked distance was 538.5 meters (413-685) and the six-minute walk test was found to be reproducible. The walked distance was significantly correlated with age (r=0.66), weight (r=0.76), height (r=0.82), the height Z score (r=0.41), hemoglobin (r=0.46), hematocrit (r=0.47) and post-test systolic blood pressure (r=0.39). The chronic kidney disease patients predicted walked distance was 84.1% of the reference value according to age, 90.6% according to age-corrected height and 87.4% according to a predictive equation. CONCLUSIONS: The stage V chronic kidney disease patients had a significantly decreased functional exercise capacity, as measured by the six-minute walk test, compared with the healthy pediatric reference values. In addition, the six-minute walk test was shown to be well tolerated, reliable and applicable as a low-cost tool to monitor functional exercise capacity in patients with renal disease.
Subject(s)
Adolescent , Child , Female , Humans , Male , Exercise Test , Exercise Tolerance/physiology , Renal Insufficiency, Chronic/physiopathology , Walking/physiology , Brazil , Cross-Sectional Studies , Dyspnea/physiopathology , Healthy Volunteers/statistics & numerical data , Predictive Value of Tests , Reference Values , Reproducibility of Results , Time FactorsABSTRACT
OBJETIVOS: Identificar fatores preditivos iniciais de envolvimento renal nas crianças e adolescentes com púrpura de Henoch-Schõnlein. MÉTODOS: Por um período de 21 anos, os prontuários de 142 pacientes com diagnóstico de púrpura de Henoch-Schõnlein admitidos em nosso Hospital Universitário foram revistos. Os fatores preditivos iniciais avaliados nos primeiros 3 meses incluíram: dados demográficos, manifestações clínicas (púrpura palpável persistente, artrite, dor abdominal, dor abdominal intensa, sangramento gastrointestinal, orquite, envolvimento do sistema nervoso central e hemorragia pulmonar), exames laboratoriais (níveis séricos de IgA) e tratamento utilizado (corticosteróides, imunoglobulina endovenosa e medicação imunossupressora). Os pacientes foram divididos em dois grupos (com presença ou ausência de nefrite) e avaliados de acordo com a análise univariada e multivariada. RESULTADOS: Nefrite foi evidenciada em 70 pacientes (49,3 por cento). A análise univariada revelou que dor abdominal intensa (p = 0,0049; OR = 1,6; IC95 por cento 1,18-2,21), sangramento gastrointestinal (p = 0,004; OR = 1,6; IC95 por cento 1,10-2,26) e uso dos corticosteróides (p = 0,0012; OR = 1,7; IC95 por cento 1,28-2,40) foram associados com uma maior incidência de envolvimento renal. Na análise multivariada, a regressão logística mostrou que a única variável independente na predição da ocorrência de nefrite foi dor abdominal intensa (p < 0,012; OR = 2,593; IC95 por cento 1,234-5,452). CONCLUSÕES: Dor abdominal intensa representou um preditor significativo da nefrite na púrpura de Henoch-Schõnlein. Conseqüentemente, os pacientes pediátricos com esta manifestação clínica devem ser rigorosamente seguidos, devido ao maior risco de acometimento renal.
OBJECTIVES: To identify initial predictive factors of renal involvement in children and adolescents with Henoch-Schõnlein purpura. METHODS: We reviewed the medical records of 142 patients admitted to our University Hospital over a 21-year period with a diagnosis of Henoch-Schõnlein purpura. The initial predictive factors assessed, observed during the first 3 months, included: demographic data, clinical manifestations (persistent palpable purpura, arthritis, abdominal pain, severe abdominal pain, gastrointestinal bleeding, orchitis, central nervous system involvement and pulmonary hemorrhage), laboratory tests (serum IgA levels) and treatment given (corticosteroids, intravenous immunoglobulin and immunosuppressive drugs). Patients were divided into two groups (presence or absence of nephritis) and assessed by univariate and multivariate analysis. RESULTS: Evidence of nephritis was detected in 70 patients (49.3 percent). The univariate analysis revealed that severe abdominal pain (p = 0.0049; OR = 1.6; 95 percentCI 1.18-2.21), gastrointestinal bleeding (p = 0.004; OR = 1.6; 95 percentCI 1.10-2.26) and corticosteroid use (p = 0.0012; OR = 1.7; 95 percentCI 1.28-2.40) were all associated with increased incidence of renal involvement. In the multivariate analysis, logistic regression demonstrated that the only independent variable that predicted nephritis was intense abdominal pain (p < 0.012; OR = 2.593; 95 percentCI 1.234-5.452). CONCLUSIONS: Severe abdominal pain was a significant predictor of nephritis in Henoch-Schõnlein purpura. Consequently, pediatric patients exhibiting this clinical manifestation should be rigorously monitored, due to the increased risk of renal involvement.
Subject(s)
Adolescent , Child , Female , Humans , Male , Abdominal Pain/etiology , Kidney Diseases/etiology , IgA Vasculitis/complications , Analysis of Variance , Kidney Diseases/drug therapy , Nephritis/etiology , Odds Ratio , Prognosis , IgA Vasculitis/drug therapy , Retrospective Studies , Risk Factors , Severity of Illness IndexABSTRACT
Objetivo: avaliar a imunidade para o sarampo em crianças e adolescentes portadores de insuficiência renal crônica. Casuística e métodos: no ano 2000, foi realizado um estudo de corte transversal com os pacientes seguidos em uma unidade de nefrologia que preenchessem os critérios seletivos: idade 18 meses e 18 anos, ritmo de filtração glomerular abaixo de 70 ml/min/1,73m2, que tivessem o cartão vacinal preconizado pelo Ministério da Saúde do Brasil...
Objective: to evaluate the immune response to measles vaccination in children and adolescents with chronic renal failure (CRF). Patients and methods: a cross-sectional study was proceeded in year 2000, with registered patients in a nephrologic unit, that fulfilled the study criteria: age range between 18 months and 18 years, glomerular filtration rate...
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Renal Insufficiency, Chronic/complications , Measles/immunology , Measles Vaccine/immunologySubject(s)
Pregnancy , Infant, Newborn , Female , Hepatitis A/epidemiology , Hepatitis B/epidemiology , Hepatitis C/epidemiology , Hepatitis D/epidemiology , Pregnancy Complications, Infectious , Communicable Diseases/immunology , Hepatitis A/physiopathology , Hepatitis B/physiopathology , Hepatitis C/physiopathology , Hepatitis D/physiopathology , Immunization, PassiveABSTRACT
Os autores relatam um caso de candidiase do aparelho urinario em lactente de cinco meses de idade e chamam a atencao para os principais fatores predisponentes: antibioticoterapia prolongada, acessos vasculares centrais, alimentacao parenteral, desnutricao e entubacao endo-traqueal.